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FOR OFFICE USE: <br /> Permit No. -- --------- <br /> FO OFFICE USE:------- ---- ------- -------- ------ --- <br /> --------------------------------------------------------- APPLICATION FOR -SANITATION PERMIT <br /> --------------------------------------------- issued <br /> ---- -- .... .. .... - --------- ----- (Complete in Duplicate) Date <br /> ----------------------------------------- This Permit Ex fres I Year From Date Issued <br /> ------------------- in described. <br /> ---------- ---- ------------ - District for a permit to construct and install the work here <br /> Application is hereby made to the Son Joaquin Local Health <br /> This application is made in compliance with County ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_ --------- A-- <br /> phone-------------------------------- <br /> ................... <br /> -------------------------------------------- <br /> Owner's Name-------- ------ ----------------------................... <br /> ----------- -- - - - ----------------------------------- <br /> ------------------------ <br /> Address__---------- ..................... Phone_....... <br /> ---•'-a--- - ------- -------- ---- ------ -- ------ <br /> Contractor's Name-------- ----Apartment rt-ment.-Hous-e__[I Commercial- - C] Trailer e r C Court [I Motel 0 Other [3 <br /> Installation will serve: Residence 4Number of baths Lot Size ---0__A0Va,%,1------------------------------------ <br /> Number of living units. -1......Number of bedrooms _1_-_-- <br /> Supply: Public system F1 Community system C] Private,g) Depth TOWater Table 7-Q--- ft. <br /> Water Sandy Loam 0 Clay Loam 0 Clay 0 Adobe C] Hardpan 0 <br /> Character of soil Gravel [I San <br /> to a depth of 3 feet: Sand 0 New Construction: Yes ;� No 0 FHA/VA; Yes E3 No C3 <br /> previous Application Made- (if yes(.,clate--------------------) No 90 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: sewer is available within feet.) <br /> (No septic tank or cesspool permitted if public sew -------------------- --------------------------- <br /> Distance from I nearest well------------------Distance from foundation--------------_---Material. ------ ................ <br /> Septi l;A, No. of compartments--------------- ----------Size--------------------------------Liquid depth----------------------.-Capacity 514 <br /> tion---1.0-4------ Distance to nearest lot line................. <br /> r rest well---jr ----Distance from foundation_ ---------------------- <br /> Y'50005al Field: Distance from nearest _4"------------------Width of trench. <br /> Number of lines---__--i----------- ----Lengtb of each line. ----- <br /> Type of filter Depth of filter material--- ----------Total length---40-0------------------ <br /> i ---------------- <br /> polo - -- ----------------Distance from foundation------------------Distance to nearest lot line-.­­------------ <br /> --------------- <br /> Seepage nearest ...................Depth <br /> it Distance to rie Size: Diameter.... <br /> ❑ <br /> Number of pits----------------------Lining material---------I-m foundation-------------------Lining materia-------------------------------- <br /> I Capacity---------------- <br /> Cesspool: Distance from nearest well..._-----------Distance7 fro Liquid ---I--------gals. <br /> Size: Diameter----- --------------------------------Depth--------------------------------------------------- <br /> - 0 1 Distance from nearest buldinq------------------------------------------ <br /> Distance fron. nearest t well------ ------ ------------------------ --------- <br /> ? � 1 .1 ---------I------------------I--------------- <br /> Distance to nearest lot line_------__.___--------- I--- --- ------------ <br /> 0 ---------------------------------- <br /> ----------------------------------- ---------------------- <br /> -----------------I----------------------- C; <br /> Remodeling and/or repairing (describe)---------------------mow.- * I <br /> --------------I----------------------------------- <br /> ---------------------------------------------------------------------------------------------- -------- ------------------- <br /> -------­------------­-----------------0------------------------------------------------------------------------------------------------------- __ e <br /> __-----_----------- <br /> --------------------------------------------- -------------------------------------------------------------------------------- <br /> ------------------------------------------------------I--------------------------•--------•------•-----d that the work will be done in accordance with San Joaquin County <br /> I herebt certify that I have prepared this application an <br /> and rules and regulations of the San Joaquin Local Health District. <br /> ordinances, state laws, <br /> -------------------------------(Owner and/or Contractor) <br /> (Signed)_.m -------a...... ------- ------------(Title)----------------------------------------------- I---------------- <br /> By:------------------------------------------------------------------------------------------------------------------------ on reverse side). <br /> (Plot i ,ilan, showing site of lot, location of system in relation to wells, buildings, etc., can be placed <br /> FOR DEPARTMENT USE ONLY <br /> DATE... --------------------------------- <br /> - <br /> APPLICATION ACCEPTED --------- ----- <br /> DATE -- -- <br /> REVIEWED BY-------------------------------- ............r--------------------------------------- <br /> ---------------------- DATE--------------------------------------I---------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------- ------------------------------- ------------------------------...----------------••------•------------ <br /> --- <br /> ------ ------------------------------------- <br /> Alterations and/or recommendations-------------------------------- ------- ------------------------------------------------ <br /> ....................­...... -----------------­I-------------- ......-------- -------- ----------------------------------------------------------------------------------- -------­-----­------­------ <br /> ­---------------------------------------------------------------_i--------------­-------------- -------I----------------------------------- ---------I-------------- <br /> -------------­--------------------­------------ -- --------------­---------------------------------------------- ------------------------ ------- <br /> --------------------------------------------------- ---------------------------------------------------------------------­ ­­---------------- ----------------------------------------- ------- -------­------------ <br /> - ---------------- ------- ------- ...... --------­--------- ----------------------- -------------------------------- <br /> V-e j - <br /> - ------------- <br /> - ---- -------- <br /> FINAL INSPECTION BYZ-0,A ---------I------------------- Date__. ----------- <br /> ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Syramor*Stf**0 205 West 91h street <br /> Tracy,California <br /> Manteca,California <br /> Stockton,California Lodi,California <br /> ES 9 REVISED 6-59 2M 5-62 ATLAS <br />